Tachycardia Transition During Ablation of Persistent Atrial Fibrillation

Arantès, Leonardo; Klein, George J.; Jaı̈s, Pierre; Lim, Kang‐Teng; Matsuo, Seiichiro; Knecht, Sébastien; Hocini, Mélèze; O’Neill, Mark; Clémenty, Jacques; Haı̈ssaguerre, Michel

doi:10.1111/j.1540-8167.2010.01964.x

Cited by 8 publications

(5 citation statements)

References 16 publications

(30 reference statements)

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“…Our analysis of approximately 150 cases in our database revealed that this phenomenon occurs in approximately one-third of the cases. Additionally, our review of the existing literature yielded consistent findings (Arantes et al, 2011;Takigawa et al, 2019;Kaiser, Rogers and Narayan, 2019). The observation that AT often transforms into a slower rhythm following ablation suggests the possibility of a secondary loop that plays a crucial role in ablation therapy.…”

Section: Revelation After Three Decades Of Ablation Therapy: Two Loop...supporting

confidence: 70%

Revelation after three decades of ablation therapy: two loops instead of a single re-entry loop drive atrial tachycardia

Vandersickel,

Hendrickx,

Van Den Abeele

2023

The Project Repository Journal

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Revelation after three decades of ablation therapy: two loops instead of a single re-entry loop drive atrial tachycardia There is an urgent need to better understand and localise the sources of cardiac arrhythmia in order to improve its treatment. SmartHeart proposes a radical new approach—applying network theory to study cardiac arrhythmia mechanisms. Network theory has myriad applications throughout biology, physics and social sciences. However, it has never been applied to the heart. In this proposal, we will apply network theory to clinical data of cardiac arrhythmia, backed up by computer simulations, to automatically detect the source of the arrhythmia for complex atrial tachycardia, atrial fibrillation and ventricular tachycardia. As we will identify possible ablation targets, the goal of this project is to improve the treatment for the patient.

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Section: Revelation After Three Decades Of Ablation Therapy: Two Loop...supporting

confidence: 70%

Revelation after three decades of ablation therapy: two loops instead of a single re-entry loop drive atrial tachycardia

Vandersickel,

Hendrickx,

Van Den Abeele

2023

The Project Repository Journal

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“…In this issue of the JCE, Arantes 33 and coworkers advance still a new hypothesis derived from observations of the regular tachycardias occurring in the transition from AF to sinus rhythm, in the course of a “staged ablation” strategy progressing from PV isolation to CFE ablation in the coronary sinus and inferior LA, then to CFE ablation throughout the LA, then LA roof line ablation, and finally mitral isthmus ablation. In 29 of 90 patients they recorded 2 or more regular tachycardias, most of them LA MRT, before attaining sinus rhythm.…”

Section: Editorial Commentmentioning

confidence: 99%

Learning by Burning in Atrial Fibrillation: An Uncertain, Complicated Quest

Cosío

2010

Journal of Cardiovascular Electrophysiology

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Editorial CommentCatheter ablation of cardiac arrhythmias has been a fantastic success in modern Cardiology because it came to fill the remaining gap from hypothesis to proof of concept. During the 1970s and 1980s studies with intracardiac recordings and programmed stimulation led to a better understanding of arrhythmia mechanisms that allowed the surgeons to start a new era in the treatment of arrhythmias. Then, catheter ablation went a step further as it allowed testing the mechanistic hypothesis by creating very localized lesions. Perhaps the best example of this is accessory pathway ablation. Disappearance of delta waves or interruption of atrioventricular (AV) tachycardia within seconds of radiofrequency (RF) application provided proof of the accurate localization of the pathway and of the mechanism of tachycardia. 1,2 The history of reentrant nodal tachycardia is a little different because the anatomic targets were not so precisely defined, but still, the abolition of conduction through one of the nodal pathways was predictive of success and again supported the dual-AV nodal pathways mechanistic hypothesis. 3,4 A significant step further was ablation of macroreentrant atrial tachycardias (MRT) because MRT circuits could be located anywhere in the atria, and to understand their mechanisms complex mapping and entrainment studies were necessary; but there was no insurmountable barrier and the precise definition of the anatomy of the circuits highlighted the location of critical isthmuses that, when targeted by ablation, made tachycardia stop. Typical atrial flutter ablation 5,6 was the start of this new story of hypothesis proof, soon followed by scar-related 7,8 and left atrial (LA) MRT. 9,10 The understanding of AF and the development of ablation techniques has followed a much more uncertain and difficult path. In the 1950s a localized origin of the arrhythmia was proposed, ascribing irregular activation to irregular, "fibrillatory" conduction, 11 but after the enunciation of Moe's multiple wavelet hypothesis 12 chaotic reentry became the name of the game. The success of Maze surgery, 13 designed to prevent free rotation of the activation fronts, supported this mechanism and sophisticated experiments by Allessie's group gave additional support by showing the coexistence of multiple, changing activation waves in dogs with vagal AF. 14 In these experiments there were some anomalies in the form of focal patterns of activation with centrifugal spread that were explained on the bases of transmural reentry. Later experimental observations started to question the strength of the multiple wavelet hypothesis by finding stable localized sources of activation causing fibrillatory conduction throughout the atria. 15,16 But it was the discovery by Haïssaguerre's group 17 of focal discharges originating in the pulmonary veins (PV) as triggers of AF that completely changed our perspective. Ablation helped support a focal mechanism, as electrical isolation of the PV eliminated paroxysmal AF in 70-80% of the patients, at lea...

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“…Alternatively, they may reflect preexisting focal drivers uncovered after elimination of fibrillatory conduction. 22 There is evidence that presentation with these arrhythmias after PV isolation, and their successful ablation, results in better long-term outcomes than presentation with continuing or recurrent AF alone. 21,23 Why is persistent AF associated with potentially more non-PV drivers?…”

Section: Articles See P 287 295 and 442mentioning

confidence: 99%

Fibroblasts, Focal Triggers, and Persistent Atrial Fibrillation

Wilber

2012

Circ: Arrhythmia and Electrophysiology

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A blation of persistent atrial fibrillation (AF) remains challenging, particularly as the duration of continuous AF before the procedure increases. Attainment of durable pulmonary vein (PV) isolation remains a fundamental goal in this population; continuous retriggering from focal peri-PV sources (both automaticity and localized reentry) as a potential mechanism for maintaining persistent AF was documented more than a decade ago. 1 An area of continuing debate centers on the extent of additional atrial ablation outside the PV antra required for long-term maintenance of sinus rhythm. Two studies published in this issue of Circulation: Arrhythmia and Electrophysiology highlight important clinical aspects of this debate. Articles see p 287, 295, and 442Inoue and colleagues 2 report long-term follow-up of catheter ablation in 263 patients with persistent AF (mean duration of continuous AF, 11 months; Ͼ1 year in 50%). To identify triggers that may perpetuate AF, cardioversion was performed at procedure onset, followed by short-duration isoproterenol infusion if needed, to provoke immediate recurrence of AF. The immediate recurrence of AF occurred in 70 (27%) of 263 patients, one third arising from non-PV foci. These triggers were then targeted for ablation (successful in all peri-PV foci, but in only 6 of 23 patients with non-PV triggers). All patients subsequently underwent PV isolation, and 72% had additional non-PV left atrial ablation. At the last follow-up of 17 months (38% of patients receiving antiarrhythmic drugs [AADs], multiple procedures in Ϸ30%), 90% of patients were in sinus rhythm, although 16% continued to have paroxysmal episodes. Immediate recurrence of AF was associated with a greater risk of recurrent persistent AF during follow-up, predominantly a result of inability to localize and eliminate non-PV focal triggers.In a randomized trial of ablation for persistent AF, Dixit and coworkers 3 evaluate 3 strategies for ablation of persistent AF: (1) PV isolationϩablation of non-PV triggers elicited by cardioversion and isoproterenol infusion (standard protocol), (2) standard protocolϩempirical ablation at sites that commonly harbor non-PV foci (superior vena cava, crista terminalis, peri-coronary sinus os, and inferolateral mitral annulus), and (3) standard protocolϩablation of sites with complex fractionated electrograms as identified by automated algorithm (cycle length, Ͻ120 ms). Single-procedure efficacy (freedom from any atrial arrhythmias without AAD) was 49%, 58%, and 29% at 1 year in the 3 groups, respectively, and 53%, 62%, and 51% at final follow-up, respectively. The latter included repeat ablation using the standard protocol in 37% of patients. Additional AAD therapy in an unspecified number of patients, and a more lenient (but clinically reasonable) definition of rhythm control, led to efficacy rates of 64%, 70%, and 43% at 1 year and 80%, 82%, and 80% at the end of the study (mean, 19Ϯ9 months after last ablation), respectively. The first 2 strategies resulted in significantly better initi...

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Tachycardia Transition During Ablation of Persistent Atrial Fibrillation

Cited by 8 publications

References 16 publications

Revelation after three decades of ablation therapy: two loops instead of a single re-entry loop drive atrial tachycardia

Revelation after three decades of ablation therapy: two loops instead of a single re-entry loop drive atrial tachycardia

Learning by Burning in Atrial Fibrillation: An Uncertain, Complicated Quest

Fibroblasts, Focal Triggers, and Persistent Atrial Fibrillation

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